Recommended Adult Immunization Schedule—United States, 2012FREE

Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the recommended adult immunization schedule to ensure that the schedule reflects current recommendations for licensed vaccines. In October 2011, ACIP approved the adult immunization schedule for 2012, which includes several changes from 2011. A footnote directing readers to links for the full ACIP vaccine recommendations and where to find additional information on specific vaccine recommendations for travelers is now included. In addition, a Table summarizing precautions and contraindications was added. This table is based on the corresponding table in the 12th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases and is included to provide ready access to key safety information for adult vaccine providers.1

Changes to the footnote for tetanus, diphtheria, and acellular pertussis (Tdap) and tetanus, diphtheria (Td) vaccines were made to update recommendations. Tdap vaccine is recommended specifically for persons who are close contacts of infants younger than 12 months of age (e.g., parents, grandparents, and child-care providers) and who have not received Tdap previously. Before 2011, vaccination postpartum was preferred for women who had not had a previous adult Tdap dose. However, in 2011, ACIP recommended pregnant women preferentially receive Tdap vaccination during later pregnancy (>20 weeks gestation). Other adults who are close contacts of children younger than 12 months of age continue to be recommended to receive a one-time dose of Tdap vaccine.

Updates to the footnotes and figures also were made for human papillomavirus (HPV) and hepatitis B vaccines based on recommendations made at the October 2011 ACIP meeting. The HPV vaccine recommendation has been updated to include routine vaccination of males 11-12 years of age, with catch-up vaccination recommended for males 13-21 years of age. HPV vaccine also is recommended for previously unvaccinated males 22-26 years of age who are immunocompromised, or who test positive for human immunodeficiency virus (HIV) infection, or who have sex with men.

ACIP also voted in October 2011 to recommend hepatitis B vaccine for adults <60 years of age who have diabetes, as soon as possible after diabetes is diagnosed. In addition, hepatitis B vaccination is recommended at the discretion of the treating clinician for adults with diabetes who are 60 years or older based on a patient's likely need for assisted blood glucose monitoring, likelihood of acquiring hepatitis B, and likelihood of immune response to vaccination.

A notation was included for zoster vaccine to acknowledge that the vaccine was recently approved by the Food and Drug Administration (FDA) for administration to persons 50 years of age and older; however, ACIP continues to recommend that vaccination begin at age 60 years. The influenza vaccine footnote was revised to specify age indications for the different licensed formulations of trivalent inactivated influenza vaccine (TIV). The footnote for the measles, mumps, rubella (MMR) vaccine was simplified to focus only on routine use of this vaccine in adults; information on use of the vaccine for outbreak control was removed. Readers are referred to the ACIP MMR recommendations and to the ACIP recommendations for the immunization of health-care personnel regarding the use of MMR vaccine in outbreak settings. Additional information on the use of quadrivalent meningococcal conjugate vaccine (MCV4) and meningococcal polysaccharide vaccine (MPSV4) for specific age and risk groups was added. Minor clarifications also were made to the footnotes for HPV vaccine, varicella vaccine, and pneumococcal polysaccharide vaccine (PPSV).

FOOTNOTE CHANGES FOR 2012

A new footnote (1), “Additional information,” has been added to the beginning of the footnotes. This footnote provides links to the full ACIP vaccine recommendations and information on travel requirements that might have been referred to previously in subsequent footnotes.

The “Influenza vaccination” footnote (2) was revised to clarify that all persons aged 6 months and older can receive TIV and that health-care personnel (HCP) who care for persons requiring a protected environment should receive TIV. HCP younger than 50 years who do not have a contraindication may receive either the live attenuated influenza vaccine or TIV. In addition, age indications for two recently licensed formulations of TIV were included. The link to additional information regarding influenza vaccination has been removed because a link now is provided in footnote 1.

The “Human papillomavirus (HPV) vaccination” footnote (5) now clarifies that although HPV vaccination is not specifically recommended for HCP, HCP should receive the HPV vaccine if they are in the recommended age group. This footnote also was changed to reflect the recommendation of the quadrivalent human papillomavirus (HPV4) vaccine for males at age 11 or 12 years and catch-up vaccination for males 13 through 21 years of age. Males 22 through 26 years of age may be vaccinated with HPV4 vaccine.

The “Zoster vaccination” footnote (6) now indicates that while zoster vaccination is not specifically recommended for HCP, HCP should receive the vaccine if they are in the recommended age group. This footnote also acknowledges that the vaccine is FDA-approved for use in persons 50 years and older; however, ACIP continues to recommend that vaccination begin at age 60 years.

The link in the “Measles, mumps, rubella (MMR) vaccination” footnote (7) that directs the reader to more information about evidence of immunity has been removed. In addition, the information about the use of MMR vaccine in outbreak settings has been removed. Readers are referred to the ACIP MMR recommendations and to the ACIP recommendations for the immunization of health-care personnel regarding the use of MMR vaccine in outbreak settings.

The “Pneumococcal polysaccharide (PPSV) vaccination” footnote (8) has been revised to include additional examples of functional and anatomic asplenia. Language is included for persons with asymptomatic or symptomatic HIV infection and persons undergoing cancer chemotherapy or who are on other immunosuppressive therapy.

The “Revaccination with PPSV” footnote (9) has been revised to clarify guidance for those aged 65 years and older who had been vaccinated with PPSV23 before age 65 and for whom at least 5 years has passed since their previous dose.

The “Meningococcal vaccination” footnote (10) has been revised to include military recruits in the group recommended to receive a single dose of meningococcal vaccine. The language about college students has been clarified to indicate that first-year college students up through age 21 years who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday. Language regarding travel to sub-Saharan Africa and travel to Mecca has been removed, and readers are referred to the footnote on information about vaccines for travelers (1).

The “Hepatitis B vaccination” footnote (12) has been revised to include persons with diabetes younger than 60 years old and persons 60 years and older based on need for assisted blood glucose monitoring.

Finally, all footnotes were changed from paragraph form to a bulleted format to provide for greater ease in use of the recommendations.

FIGURES

For Figure 1, the bar for Tdap/Td for persons 65 years and older has been changed to a yellow and purple hashed bar to indicate that persons in this age group should receive 1 dose of Tdap if they are a close contact of an infant younger than 12 months of age. However, other persons 65 and older who are not close contacts of infants may receive either Tdap or Td.

The 19-26 years age group was divided into 19-21 years and 22-26 years age groups. The HPV vaccine bar was split into separate bars for females and males. The recommendation for all males 19-21 years to receive HPV is indicated with a yellow bar, and a purple bar is used for 22-26 year old males to indicate that the vaccine is only for certain high-risk groups.

For Figure 2, a new column was added for men who have sex with men (MSM) to note in the figure that MSM is an indication for HPV, hepatitis A, and hepatitis B vaccines.

In addition, the diabetes indication was moved to the same column as chronic kidney disease to accommodate the new recommendation for hepatitis B vaccination of persons with diabetes.

Because pregnant women not previously vaccinated with Tdap are now preferentially recommended for vaccination with Tdap during later pregnancy (>20 weeks gestation), the yellow bar has been extended across all risk groups.

The HPV vaccine bar was separated into a bar for females and one for males. The bar for females is unchanged from the previous year except that the bar was extended to include HCP to clarify that HCP who are in the recommended age group for receipt of HPV vaccine are recommended for vaccination.

Lastly, the HPV vaccine bar for males was added and indicates that all males through age 26 should be vaccinated if they are immunocompromised, have HIV, or are MSM. However, the age indication is through age 21 for males with or without these risk factors.

The recommended adult immunization schedule has been approved by the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Nurse-Midwives.

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